Self-determination or self destruction?

A Message from the CEO Gillian Batt

When does self-determination become self-destruction?

As a community service, our aim is to enable senior residents to live an independent quality life in their own homes.

But what can we do when people reject our help?

Recently there was a case of a fiercely independent elderly couple who rejected all offers of help. They lived in an affluent suburb with closely located neighbours who knew of them but never saw them. Their relatives lived thousands of miles away. It appears he died of natural causes and the wife, who was very disabled, later died alone of neglect and starvation. Their bodies were discovered weeks later.

Here in Lane Cove we are dealing with two similar cases and our hands are tied.

A woman in her 90s lives in squalor and filth. She is incontinent, doesn’t eat and refuses to be showered or washed. Her weight has plummeted to 38kg. Her house is cold, but she switches off the heating the moment the nurses leave. She is obviously confused, but can be relatively coherent when questioned. She has one distant relative in his 70s who lives many kilometres away. He doesn’t drive and relies on public transport.

We called for a geriatric assessment and the registrar felt she was competent to make her own decisions, but would be best served by being in residential care, trying very hard to get her to agree to hospitalisation and transfer from there. The Aged Care Assessment Team (ACAT) assessor advised that a high-level package (designed to keep her in the home) was appropriate.

She needs to agree to take up the package (which needs a small contribution from her) which she doesn’t want to do and she still won’t allow any help. We called an ambulance to take her to hospital, but she refused to leave the house. Even the paramedic was upset, but couldn’t take her if she refused consent.

A week later we finally got her into hospital. After a couple of days, we had a phone call to say she wanted to go home and they were going to discharge her. We strongly advised against it. Three days later, at her insistence, she was sent

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home. We had not been notified of her discharge. A social worker found her on the floor. No one knows how long she had been there. She is now back in hospital.

Another elderly couple live in a large house but one that is filled with junk and mess. He has dementia and loves his very disabled wife, but he is not capable of caring for her although he does his best. However, her bedding is dirty and unwashed. He can’t look after himself, let alone his wife. Financially they could afford full time carers but refuse. We contacted the relatives to express our concerns, but they were not willing to do anything or discuss any intervention to help.

Everyday our experienced Registered Nurses return to the office very distressed by what they find and by how powerless we are to step in and help.

In our efforts to allow people to control their own lives, we have robbed some of them of their basic human dignity. We can offer a range of services to help people stay safely at home. But they need to agree to let us help them.

We see elderly people whose dementia and cognitive impairment rob them of that dignity. The push for control and self-determination, and the policy shift to enabling people to remain in the family home has cast these people adrift, barely propped up by the limited support they allow into their homes.

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